DOWNSTAGING LOCALLY ADVANCED
PANCREATIC ADENOCARCINOMA (LAPC) WITH
VASCULAR ENCASEMENT USING PERCUTANEOUS
IRREVERSIBLE ELECTROPORATION (IRE)
NARAYANAN,GOVINDARAJAN; ARORA,GEETIKA;
BARBERY, KATUSKA;FROUD,TATIANA;LIVINGSTONE,ALAN;
FRANCESCHI,DIDO; HOSEIN,PETER;
ROCHA LIMA,CAIO;YRIZARRY,JOSE
•American Cancer Society. Cancer Facts & Figures 2011. Atlanta: American Cancer Society 2011.
PANCREATIC CANCER
• 5-year survival rate of 6%
• Case-fatality rate among the highest of any malignancy
• Surgical resection offers the best chance for cure, but only
10%-20% of patients will qualify
WHAT IS LOCALLY ADVANCED
PANCREATIC CANCER (LAPC)?
Pancreatic cancer that has not spread to distant organs
(Non-metastatic disease) but is inoperable due to encasement
of major blood vessels.
CURRENT TREATMENT OPTIONS
• Surgery
• Chemotherapy
• Radiation therapy
WHAT IS IRREVERSIBLE
ELECTROPORATION (IRE)?
A focal ablation therapy that uses high voltage low energy
DC electrical pulses to permanently open pores in the cell
membranes of soft tissue, which causes cells to die.
NANOKNIFE GENERATOR
•
Has a 510(k) clearance from the
FDA for soft tissue ablation
• Use in organs is considered
off-label
THERMAL ABLATION OPTIONS
• RADIO FREQUENCY ABLATION
• MICROWAVE ABLATION
PURPOSE OF THE STUDY
• Safety of IRE in treating Pancreatic Cancer without
open surgery with imaging guidance
• Resection rate in LAPC after using IRE
TREATMENT CRITERIA
• Patients who failed previous chemotherapy and
radiation treatment
• Patients with unresectable pancreatic tumors
• Patients with minimal and stable metastatic disease
RECENT ANALYSIS
• 8 patients treated between 12/2010 – 9/2011
• Most patients had received prior chemotherapy and or
radiation
• Median time between diagnosis and IRE: 9 months
• 2 went to surgery. Both had successful resections and
remain cancer-free. ( 346 and 225 days post surgery)
WHY THIS MATTERS TO PATIENTS?
• A new option, with potential ability to down stage
• Minimal side effects and morbidity
• Other treatment options can still be used
PANCREAS IRE
CASE
•
•
•
•
65yr old female
Biopsy proven pancreatic cancer
Received Chemotherapy and radiation
Inoperable due to vessel encasement and residual
disease
PRE IRE CT
Tumor after chemotherapy and radiation therapy
Celiac axis and SMA encasement
11/10- ELECTRODE PLACEMENT
UNDER CAT SCAN GUIDANCE
IRE probe placement
IMMEDIATE POST CT SCAN
Unaffected vessels and air surrounding the treatment zone
FOLLOW UP CT 3/11
Vessel encasement
SURGERY 4/11
• Tumor involved body & neck
• Distal Pancreatectomy & Splenectomy
• Proximal pancreatic margin frozen sample- Negative
PATHOLOGY
Extensive fibrosis
Residual Intraductal Mucinous Ca
FOLLOW UP
 Follow up days: 421
 CT :1/24/2012: No enhancing mass- No evidence of
Disease
 Disease status: Stable
 CA-19-9: Decreasing trend from 24.2 to 15.8
What we know & Where we go from here
• Can be done safely with imaging guidance.
• Early results in a small number of patients is
promising
• Trial to validate these results
Thank You